by Barbara Ebel
“Not as bad as the thought of it.”
When they all sat down for lunch, neither boy mentioned to their mother the appetizer that Toby had already ingested.
-----
Mrs. Owens and her son left the pediatrician’s office after Toby’s appointment with Dr. Gillespie and drove straight home. It proved to be a gorgeous sunny day, perfect for the basketball game that Toby and his friends agreed on for that afternoon. Without much enthusiasm for his favorite peanut butter and jelly sandwich, he ate lunch and went to the solitude of his room.
Toby kicked off his shoes and plopped onto his bed. He had actually made his bed that morning, but there wasn’t much else in the room that looked that neat. Dirty clothes hung on the back of his chair, sneakers and socks were strewn on the floor, and two sets of earbuds were tangled up on his nightstand. A thumbtack had fallen out of his bulletin board and a poster was dangling in midair. And although he had emptied his clothes to be washed from his Florida vacation two weeks ago, his suitcase was open and empty on the floor.
The youth yanked the pillow out of the covers and propped it behind him. The thought of going to the nearby park to shoot some baskets became less and less inviting to him. His bed felt too damn comfortable.
He crossed his ankles and heard the landline phone ring out in the hallway. His mother answered, rapped on his door, and stuck her head in. “Jonathon’s on the phone.”
Toby padded to the door with a grimace. Half the kids his age were walking around with their own cell phones, but his parents were not springing for his until he turned thirteen. “Thanks, Mom.” He turned back with the portable.
“What’s up?” Toby said.
“I thought you’d be here by now.”
Toby glanced over at his digital clock. “If you’re at the park, you’re fifteen minutes early.”
“So? What else is there to do? We can warm up before the other guys get here.”
“I only just got home.”
“Where’ve you been?”
“I got my school physical out of the way. I hate going to the doctor’s office.”
“I don’t mind it. My mother takes me to Dr. Clark. She’s really cool and funny sometimes.”
“I know her. She’s in the office with my pediatrician, Dr. Gillespie. Maybe I could change doctors.”
“I bet your mother won’t do that. What don’t you like about him?”
Back on his bed, Toby put one knee over the other and rubbed his calf with his free hand. “I don’t know. He’s too quiet and seems odd. At least my mother was with me in the exam room today.”
“You’re the one who’s odd. So how’d your physical go? Did you manage to get out of going back to school?” Jonathon laughed. “Maybe I can come up with some lame excuse on my doctor’s visit to stall sixth grade!”
“That’s a lame idea. I already passed my school physical.”
A lull surfaced in the conversation. Toby switched the phone into his left hand, switched legs, and massaged his left calf with his right hand.
“So what’s taking you so long?”
Their other friend, Robby, sprinted into their local sports building and pointed his thumbs up at Jonathon.
“All right already, I’m on my way.” Toby placed the phone back in the cradle outside his room and weaved his way through the neighborhood to the county office buildings and community center. After signing in, he stepped into the basketball court.
Without a hello, Robby pitched him the ball. “It’s not like you to be the last one here.”
Toby dribbled the ball to warm up, and then Jonathon put his hands on his hips after waiting too long for his buddy to throw or toss the ball.
“Doesn’t walking over here count as a warm-up?” Jonathan asked.
Toby scowled and ran to the basket, but his shooting hand wasn’t in line with the rim and he made a lousy shot. For the next ten minutes, Jonathon and Robby had complete control of the ball. They sprang up like their sneakers were light-footed appendages and they were mustering up as much fun as possible, pushing away the thought of school starting soon.
Toby continued, giving the sport and his friends his best attempt. But he wasn’t sure if his heart wasn’t in the game or if it was his body. He went to the wall and slid down to the floor.
“What are you doing?” Jonathon asked, bouncing the ball in front of him.
Toby flexed his knees and wrapped his arms around them. “Watching your sneakers toe in. I swear you do it even when you’re in the air in the middle of a shot!”
Jonathon brushed off his remark and kept working the ball. “Time’s up.”
“I gotta rest my legs. I must be tired.”
Robby wiped some sweat off his forehead. “Why don’t you go buy a banana from the snack bar inside? My mom says they help when you’re playing sports and your potassium gets low.”
“Come on,” Jonathon said. “We’ll go with you.”
-----
A little after 5 p.m., Dr. Gillespie hung his white coat on a hook behind the front desk and noticed the students. “Unless Dr. Clark needs you two, you’re finished for the day. Be back bright and early at 8 a.m.” He nodded at his employees to do the same. He was the first to leave work behind, his small-scale steps like a pigmy’s as he went out the door.
“If I remember correctly,” Heather Clark said to the students, “the first day of a new rotation can be overwhelming. Not that either of you had a difficult day today. I’m referring to the volume and scope of material you need to ingest over the next few weeks. These two weeks will be your easier part before you do your pediatric stint, with overnight call, in the hospital. So, I suggest taking as much time in the beginning to read.”
Annabel and Stuart followed her into the kitchenette. Heather was slightly overweight and had full robust cheeks and a warm smile. Annabel already assumed that her young patients opened up to her quite easily.
“Dr. Clark,” Annabel said, “do you have any words of advice about pediatrics for Stuart and me?”
“Sure. Sit down. The best thing to do in peds is to segregate your patients in your mind. In internal medicine, you can categorize patients into adult, middle-aged folks, and the distinct elderly geriatric patients. But a child is way more compartmentalized because they are growing and developing. We deal with infancy, preschoolers, middle childhood years, and adolescence. And each of those periods can be categorized into their own developmental milestones. In pediatrics, we must know what’s normal for the age in question because that then allows us to spot what’s abnormal. Which in turn allows us to diagnose and potentially correct or thwart a medical problem that could become worse.”
Stuart nodded and Annabel leaned back in her chair.
“As far as growth, there is a basic pattern that is normal. A surprising fact is that after an infant is born, they will initially lose weight, a whole five to ten percent of their birth weight. Then by about two weeks old, that infant should start gaining weight and grow quickly, so that by four to six months old, the infant’s weight should have doubled. I always find it amusing when parents come in with their baby, exclaiming how big he or she grew during that time, as if theirs is unique like a superhero character.
“Ha.” Heather chuckled. “Once, a father came in holding his infant on his shoulders and proclaimed he was raising the next Superman. His wife told him to quit bragging or other parents would put kryptonite in the waiting room.
“However, the second half of the first year, growth is not as dramatic, and then, at the toddler age of one to two, and up to age five, they’ll gain about five pounds per year. The child’s development should remain steady, but then a final growth spurt should take off.”
“Puberty?” Stuart guessed.
“Sure thing. Between nine and fifteen. Imagine, also, the nutrient needs during these ages. That small infant growing like a weed needs a lot of calories in relation to its size and, later, the same thing happens with the adolescent.
“
A healthy child will fall into a normal growth curve and yet follow his or her own individual pattern. In my opinion, never in a human being’s life are healthy diet habits more important than in the pediatric population. Parents play a significant role to prevent problems for their children, especially obesity.
“If kids aren’t eating a proper diet, they’ll be tired at school, be slow to learn, or get sick. I try to encourage parents to send their kids to school after a decent breakfast.”
Dr. Clark scooted her iPhone close and picked it up. “Even though this information is well known to me, I carry the data with me. I will, however, give both of you a paper copy separate from what you can find in your textbook.” She tapped on an app and handed it to Annabel.
Annabel scrolled the list of developmental milestones, each one specific for each age. Four, nine, twelve, and eighteen months were listed as well as two to five, and then a preschooler, school-age, and a puberty and adolescent developmental list. She handed Heather’s phone to Stuart. “I never gave this information much thought. Like you alluded to, you are taking care of a glut of patients with these age-specific growth periods and developmental milestones. What if you miss something?”
“Exactly,” Heather said.
“I had a patient on OB,” Annabel said, “who delivered a girl who was soon diagnosed with osteogenesis imperfecta. The pediatrician caught that abnormality right away with DNA testing.”
“Which is the way it should be. That baby’s brittle bones will probably change her progression on her growth curve, but the doctors will know about it.”
Stuart finished scrolling the list and handed it back to Dr. Clark. She grinned at the students. “I hope I didn’t keep you two too long.”
“On the contrary,” Annabel said. “Time spent with you was more fruitful than that time buried in a book.”
Heather rose. “Tomorrow then.” But before they left, she handed them the paper she promised them.
CHAPTER 4
Annabel stood on the porch of the pediatrician’s office, leaning against one of the stately white vertical columns. She scrolled to the car service app on her phone to schedule a ride home.
Stuart looked back from the bottom step. “You want a ride home?”
“I wouldn’t want you to go out of your way.”
“Come on,” he said as he waved.
Never invited to ride in Stuart’s vintage car before, Annabel bounded down the steps. The black 1984 Jaguar coupe was parked in the back of the building in the corner and Stuart ran his eyes over all four sides.
“Do you check her over every time?” Annabel asked.
“Routinely. Somehow, she’s still ding-free and squeaky clean.”
Annabel got in on the opposite side and settled into the tan interior leather. “How many miles does it have?”
“Eighty thousand.”
“Nice.”
“Your car will record a low odometer reading too if you keep calling Uber to ride you back and forth on your rotations.”
“Yeah, but my car is just transportation. My SUV is not a Jaguar.”
Stuart smiled and started the ignition while Annabel took out her iPhone. He peered over at her. “Which one are you calling?”
Annabel made a face at him and Stuart raised his eyebrows.
“It’s a legitimate question,” he said. “Are you calling our medical student friend or your boyfriend; or vice versa whichever.”
“Stuart! More and more, people are giving me grief about who’s who. For once and for all, Bob is my medical school friend. And yours too. And Dustin is my boyfriend.”
“Whatever you say.”
“Let’s compare notes with Bob. He can tell us about the first day of hospital pediatrics and we can fill him in on Gillespie and Clark’s private practice.” She tapped his number and he answered right away.
“Hey, Stuart and I are finished for the day. How about you?”
“Just leaving. I never expected to be out before six. Can’t complain.”
“I have an idea. How about I walk Oliver and we all meet at Pete’s Café?” She glanced at Stuart.
“Good idea,” Bob said. “See you soon.”
Stuart nodded when she got off the phone. “I’ll eat with you two.”
“I’m glad. I did store some decent leftovers for the week at home, but I can save them.”
“Me too.”
“Do you cook when you’re home or do you mostly grab food from outside?”
Stuart waited for a light at an intersection. “I sautéed chicken with vegetables yesterday and made brown rice. I parceled out four more dinner containers for the week after I ate.”
She gave him a side-glance.
“I do more than study, you know.”
“Sorry. You never mentioned your cooking talents before.”
“No different. You never talked about your sister before, not like today.”
“Cooking and a death in the family are two different things. It’s just that you earned a reputation among the medical school students as being brainy and quiet. During internal medicine, our team grew to know you more than before. We all enjoyed your company; you sure are easy to work with.”
“Because I blend into the wall and don’t cause any trouble.”
Annabel flinched. Had she and Bob and some of the others made him feel uncomfortable on some of the rotations?
“Don’t give me a second thought. I’m probably going into psychiatry because of my own awkward self, which allows me to understand those in need better.”
She wondered where he was coming from and realized how little she knew about him after three years of medical school and all the months of sharing the wards with him. “You don’t hog a conversation, Stuart, but I wouldn’t call that awkward. I bet your parents don’t think you’re awkward or timid or whatever you want to call it.”
“My parents ….” He left the words dangling in the air after a note of cynicism in his voice.
“What about them, Stuart?”
“I was adopted. I grew up in a children’s home. My parents who took me in did so when I was ten years old. They had one of their own, a boy, who was three years older. They suffered with a few miscarriages after him, so I was their attempt to bring an unfulfilled second child into their home. But their idea of an instant child was different from the reality of me and I don’t think I measured up to what they wanted.”
“Wow. Do you wish you had stayed in the children’s home, although that must not have been much fun?”
“Both experiences had their drawbacks.” He shrugged his right shoulder.
“Your background makes you more exceptional. Heck, your class rank has been unbeatable. You’re super smart despite the precarious home life you’ve dealt with.”
Stuart sighed and allowed himself a small smile. “I read books to escape. In my teen years, I started reading more and more advanced material while my parents were ogling over my older brother’s sports accomplishments.”
Annabel shook her head. “Aren’t you glad you did?”
“You’re probably thinking I wouldn’t be where I am now if my situation had been different. I realize that and try to justify what happened. Don’t get me wrong, my parents aren’t really bad people. Underneath their narrow focus, they meant well.”
“I can understand. What about medical school? Are they helping you out financially?”
“They pay my rent, which is something. Otherwise, by the end of next year, I’ll be strapped with a six-figure loan debt for med school.” He glanced over. “You’re lucky.”
“I’m grateful for my situation, Stuart. My parents work hard, and my grandparents did too. Actually, their work ethic, which resulted in success, has spilled down to me and made things easier for me, at least financially. As you know, I don’t take it for granted, and I’m working hard to become a doctor just like the rest of our classmates.”
Stuart came to the intersection of Pete’s Café and Annabel pointed. “My ap
artment is down this street. Park anywhere you find a spot.”
After circling the block and parking, the two students jumped out of the Jaguar.
“Bob may be at Pete’s already,” Annabel said. “I’ll go fetch Oliver and walk him. You two sit outside and I’ll bring him with me. After all, he’s Bob’s dog too.”
“You two made an unusual arrangement to share a dog,” he said, shaking his head.
Annabel slung her backpack on her shoulder. “It’s about time you meet him as well. Oliver, that is.”
-----
Annabel ran up the two flights of stairs to her apartment. During all of medical school, she had been the tenant of the third story of the residential house and now, more than ever, she absolutely looked forward to opening her door when she arrived home. That was because of her new dog, Oliver, whom she shared with Bob Palmer. The two medical students’ schedules were hectic, but between the two of them, they could usually avoid Oliver staying by himself for extremely long days.
She inserted her key and flung open the door to an eager face with big brown eyes. Oliver’s long billowy tail swung back and forth with glee to see her.
“Oliver, look at you!” Annabel ditched all her things on the kitchen counter and leaned down. While she wrapped her arms around his head and torso, he obliged and leaned against her. She rustled his soft, long coat and planted a kiss on his forehead, smack between his eyes.
She rose and scanned the kitchen floor and her bedroom. “You are a marvelous dog to hold your bladder since seven thirty this morning. Come on, let’s spring you out of here. Get your leash.”
Oliver went halfway to the dangling red and white striped leash draped on the stool but rethought her command.
“Yes, go fetch you leash.”
Oliver swung around and gripped the leash in his mouth, jimmied it off, and brought it over.
“Good boy!” She hooked him up, grabbed a pet clean-up bag, and they scurried down the steps side-by-side. The dog wasted no time raising his leg to the tree out front and they hustled up the block. She remembered her past walks up to the Cafe and acknowledged to herself that it was much more fun when Oliver accompanied her. Even her running with him through the neighborhood and down to the Ohio River had become much better too.